361 final

1. Amory/Moody 1
Jack Amory & Drayton Moody
HLTH 361
Khoa Truong
9 December 2014
The Economics Behind Physician Assisted Suicide
Introduction/Background/Significance
In April 2014 Brittany Maynard, a 29 year old woman from California, was diagnosed
with grade 2 astrocytoma and told that she had 6 months to live. Maynard’s rapidly growing
brain tumor was putting her in excruciating pain and left her facing a debilitating, painful, and
certain death (Luscombe 2014). After hearing this devastating diagnosis, Brittany decided that
she did not want to spend the final weeks of her life suffering and made the move to Oregon to
employ the use of Oregon’s Death with Dignity Law. Maynard stated, “death with dignity is the
best option for me and my family” (Luscombe, 2014). Brittany Maynard took advantage of a
form of suicide known as physician assisted suicide (PAS). The Canadian Medical Association
defines physician assisted suicide as knowingly and intentionally providing a person with the
knowledge or means or both required to commit suicide, including counseling about lethal
doses of drugs, prescribing such lethal doses, or supplying the drugs (CMA 2007). Many times,
physician assisted suicide is confused with euthanasia, which is different in that euthanasia
involves performing an act that is intended to end another persons life. PAS usually takes place
with a lethal dose pill and is done on the patient’s own time, while euthanasia is an injection
usually performed by the physician. Physician assisted suicide is legal only in limited areas such
as Oregon, Washington State, Switzerland, and the Netherlands. The outlook on the continued
legality in these areas is uncertain, as many find the act unethical or not economically feasible.
With skyrocketing healthcare costs and with limited resources to pour into the system, the
implications behind a decision such as physician-assisted suicide could not be more relevant.
Society today places a focus on the moral consequences of medically ending an individual’s life
over the economics behind one’s choice. At the end of the day, the question ultimately boils
down to this: Is the moribund individual in charge of making his or her own rational decision at
the margin?

2. Amory/Moody 2
Specific Aims
This paper aims to analyze the benefits and costs associated with physician assisted
suicide. An analysis of how denying physician assisted suicide saps funds from the healthcare
system due to increasing costs will be covered. Furthermore, this essay addresses economic
choice, specifically focusing on the impact on the economy of the rich and the poor when faced
with whether or not to go through with PAS. Finally, the limited resources of our world are
discussed as we consider whose decision it is to deviate money from those who can be cured to
those on palliative care who wish to end their life. The focus of this paper is not on the morals
or opinions on whether it is ethical to offer physician-assisted suicide to the medically terminal;
it is about the economics behind allowing freedom of rational decision-making at the margin.
Conceptual Framework/AnalyticMethods
In order to show the implications of legalizing physician assisted suicide, we will be
applying the economic concept of marginal benefit and marginal cost. Marginal benefit is
defined as the additional benefit from a one-unit increase in the activity, while marginal cost is
defined as the additional cost associated with a one-unit increase in the activity. As rational
consumers, we are expected to maximize our benefit by comparing benefit to cost at the
margin (Truong, 2014). The framework of this model is applicable to physician-assisted suicide
in that it allows society to see situations in which PAS would be necessary and economically
efficient. Another important concept used to show the side effects of legalizing or outlawing
PAS are externalities, defined as the side effects of production and consumptions that impacts
individuals not directly involved in the activity or transaction (Truong, 2014). Furthermore,
cost-benefit analysis is the most appropriate method to tackle PAS because it puts aside any
opinionated viewpoints and focuses on the economics of medically ending one’s life. While this
paper exemplifies the validity of legalizing PAS and the effect it may have on the economy, it
cannot change ingrained values and preconceived notions such as religious beliefs and moral
values. More specifically, the moral implications behind the procedure will continue to be
vague, as the economic advantages of legalizing PAS will not be able to override an individual’s
perceptions of right and wrong. Above all, the issue relies on society’s definition of suicide.
Many argue that physician assisted suicide may be the incorrect name entirely because it

3. Amory/Moody 3
includes the word “suicide,” which is a difficult argument to make when the individual is
already in excruciating pain from a terminal illness.
Results/Critiques
In the world of economics, resources are finite. There are a fixed quantity and quality of
resources along with a fixed level of technology. When care is given to one individual, another
loses the opportunity for that care. In the case of physician assisted suicide, forbidding those
with terminal illnesses to have access to physician-assisted suicide uses up valuable resources,
thus taking them away from other members of society. There are dramatic cost savings that go
along with legalizing PAS. When adjusted for inflation, the last month of end of life care costs
nearly sixteen thousand dollars (Emanuel and Battin, 1995). Because the majority of patients
who qualify for physician-assisted suicide require months of expensive medication and hospital
care to prolong their life, these savings are further intensified. According to a study done at The
University of Manitoba, 8.5% of terminally ill patients “acknowledged a serious and pervasive
desire to die” (Chochinov, Wilson, Enns, et al, 1995). Thus, adjusted for inflation, the
percentage of terminally ill patients who choose to medically end their life two months early
will save 7.28 billion dollars each year in medical expenses in the US (Emanuel and Battin,
1995). This drastic number exponentially increases the supply of available medical care in the
United States. According to the law of supply, as the supply of available healthcare increases,
the price of receiving that service decreases (Truong, 2014). Thus, physician assisted suicide not
only frees up medical resources such as medicine and hospital beds, but also increases access
into the systemby lowering the monetary barriers of entry into the medical system.
Further economic motives can be brought to notice by considering a theoretical
example of an extremely wealthy, however terminally ill patient. In this situation, infer the
wealthy patient choosing physician-assisted suicide has the medical requirements necessary to
qualify. Part of the reasoning for this patient’s choice is their wish to leave money to his or her
family instead of spending it on healthcare. Adjusted for inflation and the steep rise in
healthcare costs, the average cost of end of life care is over fifty thousand dollars (Emanuel and
Battin, 1995). For this patient, the opportunity cost of the extra few weeks of life is not worth
the huge sum of capital it takes to sustain their life. In our world of limited assets, these

4. Amory/Moody 4
doctors, nurses, hospital beds, and other resources could be better put to use towards curing
an individual. Furthermore, It is important to note that even without this wish to bequeath
money to their family, the patient would not want to live any longer than absolutely necessary
due to extreme suffering caused by their condition. Society would likely not deny PAS to this
individual, even if the choice were made for solely economic reasons. Many may disagree with
the wealthy patient’s choice, but because the wealthy patient was competent and had
sufficient wealth to make the decision on their own, society would be less likely to object to his
actions.
Having examined how physician assisted suicide may impact society and the wealthy
individual, it is important to consider the same situation involving a terminally ill poor patient.
Unlike the wealthy patient, the poor patient’s family would not be left with enough money to
live decently unless the patient chooses PAS. This scenario is more unfortunate. Economic
motives may pressure the patient to take his life early, leaving many to believe that the poor
patient’s decision is not voluntary. Applying the economic marginal analysis model, however,
one can readily see that the patient is making a completely rational decision just as the wealthy
patient did. Denying an individual their freedom of choice does not fall in line with the
fundamentals of economics. Building on this, in many instances the taxpayer or medical center
is paying for the palliative care for poor patients. The exorbitant costs of end of life care now
have a twofold impact on the economy. The three factors of production, land, labor and capital,
are now not the only resources being consumed to keep a dying patient alive. The taxpayer
now bearing the economic burden in the form of an externality, meaning the individual’s choice
is impacting society. This economic externality further saps money that could have been used
elsewhere to stimulate the economy.
The first economic concern regarding PAS is that patients may feel pressured by their
healthcare providers to request physician-assisted suicide. These providers include their
physicians, hospitals, or any type of managed-care facility. Most plans that are managed care
receive their funding from employers that are self-insured (Mehlman, 2014). Managed care
plans are designed to reduce spending in two ways: either by keeping costs down for the
employer, or to save money by not using the full premiums. The organizations participating in

5. Amory/Moody 5
managed care plans use different methods to have physicians keep down spending on
members of the plan. These methods can be by sharing the risk or the profits, also known as
capitation, where a predetermined amount of money is kept from the physician’s fee and given
back to the physician at the end of the fiscal year if the desired fiscal efficiency is reached. This
may cause physicians to feel pressured to encourage their patients to participate in PAS due to
the massive saving implications.
A second concern is that patients will feel pressure from their own families to request
physician-assisted suicide. Families may pressure the patient into thinking that it would be best
for them to leave money behind instead of “wasting” the money on terminal care for
themselves. The patient may also feel that their families already spend too much or do not have
enough money because of unwise decisions. These fears may obligate the patient to help fix
those financial problems by ending their life with PAS. As mentioned before, it is estimated that
7.2 billion dollars could be saved each year by legalizing PAS, giving substance to the concern
that families may be able to pressure their family members into ending their life early (Emanuel
and Battin, 1995). If the patient does not have any form of life insurance, the pressures could
be even more prominent.
The final concern is that a patient may feel the need to request physician-assisted
suicide on their own without any type of push from their families and other relationships. For
many, this is not a concern as it comes down to individual beliefs about the issue. Is it unlawful
or unethical for the patient to decide to end their life early to avoid pain and save money? This
question is outside the realm of economics, and thus cannot be answered. From an economic
standpoint legalizing PAS is the correct direction to head in, as for many individuals the
marginal benefits outweigh the costs. Nevertheless, our world has many facets beyond the
economic realm so religious, cultural, and moral conflicts must be addressed as well.

6. Amory/Moody 6
Works Cited
Chochinov, Harvey, Keith G. Wilson, and Murray Enns. "Desire for Death in the Terminally
Ill." American Journal of Psychiatry 152.8 (1005). Web. 3 Dec. 2014.
<http://psycnet.apa.org/psycinfo/1996-92637-001>.
Emanuel, Ezekiel J., and Margaret P. Battin. "What Are the Potential Cost Savings from
Legalizing Physician-Assisted Suicide?" New England Journal of Medicine (1998). Web. 3
Dec. 2014. <What Are the Potential Cost Savings from Legalizing Physician-Assisted
Suicide?>.
"Euthanasia and Assisted Suicide (2007 Update)." Canadian Medical Association. CMA, 2007.
Web. 3 Dec. 2014. <http://policybase.cma.ca/dbtw-wpd/Policypdf/PD07-01.pdf>.
Luscombe, Belinda. "The story behind Oregon's controversial Death With Dignity Act." Time.
N.p., 8 Oct. 2014. Web. 3 Dec. 2014. <http://time.com/3481599/brittany-maynard-
death-with-dignity-oregon-right-to-die-law/>.
Mehlmen, Maxwell J. "Economic Motives for Physician-Assisted Suicide." The Doctor Will See
You Now. N.p., 2014. Web. 3 Dec. 2014.
<http://www.thedoctorwillseeyounow.com/content/bioethics/art1976.html?getPage=4
>.
Truong, Khoa. "Economics Lecture." Clemson University. 2014. Lecture.